Turbinate hypertrophy is a permanent enlargement of the turbinates on the side wall of the nose and a common cause of a blocked nose. Ear, nose and throat specialist Op. Dr. Süleyman Kumbasar, whose practice is in Bahçelievler, Istanbul, uses endoscopy and a decongestant test to tell whether the enlargement comes from the lining or the bone. Treatment starts by controlling causes such as allergy; if the response is not enough, radiofrequency or surgical reduction is used, preserving the natural function of the turbinate.
What is turbinate hypertrophy?
Turbinate hypertrophy is a permanent enlargement of the turbinates, which sit on the side wall of the nose, narrowing the airway. The turbinates are lining-covered ridges that warm, humidify and filter the air we breathe; the one that most affects blockage is the inferior turbinate. It should not be confused with adenoids in children.
The turbinates naturally swell and shrink during the day, so it is normal for the blockage to switch sides. In hypertrophy, the swelling becomes permanent and can cause marked blockage on both sides.
What causes it?
Enlarged turbinates are usually the result of another underlying condition:
- Allergic rhinitis: repeated swelling of the lining exposed to the allergen
- Non-allergic rhinitis: oversensitivity to triggers such as temperature changes, smells or smoke
- Deviated septum: compensatory growth of the turbinate in the wider passage, on the side opposite the deviation
- Using decongestant nasal sprays for days or weeks (rhinitis medicamentosa)
- Hormonal changes, such as pregnancy, and environmental irritants
What are the symptoms?
The main symptom is a blocked nose; it is often worse when lying down and can switch sides. It may come with mouth breathing, a dry mouth, snoring, a reduced sense of smell, postnasal drip and a runny nose. These symptoms are similar to those of a deviated septum and sinus conditions; the difference is made on examination. A comparison of common causes is in the article causes of a blocked nose.
How is it diagnosed?
The diagnosis is made by an ear, nose and throat examination. The inside of the nose is examined with an endoscope and a decongestant test is done: if the turbinate shrinks clearly after it is applied, the enlargement is mainly from the lining; if it does not, it comes from the bony structure. This distinction guides the choice of treatment. If allergy is suspected, allergy tests are done, and if there is a deviated septum, its contribution is also assessed.
How is turbinate hypertrophy treated?
Treatment first targets the cause. In allergic rhinitis, avoiding the allergen and nasal steroid sprays prescribed by the doctor are the first step. Decongestant sprays should only be used for a few days; long-term use can make the turbinates swell even more. Saline nasal rinses soothe the lining.
If the blockage persists despite medical treatment, turbinate reduction procedures are considered. The basic principle is not to remove the turbinate completely, but to reduce its volume while preserving its function; over-reduction can cause a dry nose and a feeling of not being able to breathe.
Radiofrequency reduction
A fine probe delivers radiofrequency energy into the inner tissue of the turbinate while the surface lining is preserved. The procedure is done under local anaesthetic, usually in 15–20 minutes, and most patients return to daily life the same day. The effect appears within a few weeks as the tissue heals.
Surgical reduction
When the enlargement is bony, the turbinate bone can be moved outwards (lateralisation), or some bone and tissue can be removed from under the lining (submucosal resection). These methods are usually done under general anaesthesia and often in the same session as septoplasty. If there is also a cosmetic concern, they can be planned together with rhinoplasty.
What are the risks?
In the first weeks, crusting, slight bleeding, a runny nose and a temporary increase in blockage are expected. Rarely, prolonged dryness and crusting can occur. If the underlying allergy is not treated, the turbinates can swell again over time; that is why treatment of the cause continues after the procedure.
The surgical process
Under local anaesthetic, usually in 15–20 minutes. Most patients return to daily life the same day.
Usually under general anaesthesia; often in the same session as septoplasty.
Radiofrequency needs no hospital stay. For surgical reduction, discharge on the same day or the next day.
No packing is used with radiofrequency. For surgical reduction, its use depends on the surgical plan.
Recovery timeline
While the tissue heals, the blockage may temporarily increase; crusting and slight discharge occur. Saline nasal rinses are recommended.
Crusting decreases and breathing starts to open up. The inside of the nose is cleaned at the check-up.
The effect of radiofrequency becomes clear; after surgical reduction, internal healing is largely complete.
The result is assessed. If allergy treatment is needed, it continues.
Frequently asked questions
Are turbinates and adenoids the same thing?
No. Turbinates are structures everyone has on the side walls of the nose. Adenoids are lymphatic tissue behind the nose, in the nasopharynx, that is often enlarged in children. Both can cause blockage, but their treatment is different.
Do decongestant sprays make the turbinates grow?
Decongestant sprays lose their effect if used for more than a few days and, when stopped, the turbinates swell more. This cycle can cause rhinitis medicamentosa and permanent blockage. How long to use them should be planned with the doctor.
Is turbinate reduction painful?
Radiofrequency is done under local anaesthetic, so pain during the procedure is usually limited; afterwards there may be mild discomfort and blockage for a few days. Surgical reduction is done under general anaesthesia, and pain afterwards is usually controlled with oral painkillers.
Are the turbinates removed completely?
No. The turbinates warm, humidify and filter the air. Removing them completely can cause a dry nose and a feeling of not being able to breathe, so only their volume is reduced.
Can turbinate reduction be done together with septoplasty?
When indicated, yes. If a deviated septum and enlarged turbinates together cause the blockage, both procedures can be planned in the same session. The procedures needed are determined by endoscopic examination.
If I have allergic rhinitis, is turbinate reduction enough?
Turbinate reduction can reduce blockage, but it does not treat the allergy. Allergy symptoms such as sneezing, itching and a runny nose can continue and, without allergy treatment, the turbinates can swell again over time. That is why allergy treatment continues after the procedure.
Related treatments
Articles on this topic
Sources
- Han JK et al. Clinical Consensus Statement: Septoplasty with or without Inferior Turbinate Reduction. Otolaryngology–Head and Neck Surgery, 2015.
- Seidman MD et al. Clinical Practice Guideline: Allergic Rhinitis. Otolaryngology–Head and Neck Surgery, 2015.
The information on this page is for general guidance only; diagnosis and treatment decisions are made by the doctor after a consultation. Results of surgical and interventional procedures vary from person to person.